An interventional study of QYM Technique in Thoracic Aortic Dissection, Thoracic Aortic Aneurysm (true Aneurysm) and Thoracic Pseudoaneurysm, sponsored by Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine. Active, not recruiting at 1 site in China. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2024-10-15.
Sponsored by Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine · Not applicable, Interventional, and Treatment
Background: This study investigates the safety and efficacy of a novel surgical approach combining thoracic endovascular aortic repair (TEVAR) and in situ fenestration reconstruction of supra-aortic branches using the Quick Yielding Modified (QYM) technique. This procedure aims to address complex aortic arch diseases, providing an alternative to more invasive open surgical interventions.
Methods: This is a prospective, multicenter, single-arm, interventional study involving 87 patients across 3 centers. Eligible participants are adults aged 18-80 diagnosed with thoracic aortic dissection, thoracic aortic aneurysm (true or pseudo), penetrating aortic ulcer, or intramural hematoma, necessitating supra-aortic branch vessel reconstruction. The surgical protocol involves TEVAR combined with the QYM technique for fenestration and revascularization.
Primary Outcome: The primary endpoint is the incidence of major adverse events (MAE) within 30 days post-operation.
Secondary Outcomes: Secondary endpoints include 12-month aortic treatment success, all-cause mortality, aortic-related mortality, incidence of severe adverse events, occurrence of Type I/III endoleaks, stent graft migration, patency of revascularized branches, and rates of conversion to open surgery or reintervention due to aortic complications.
Inclusion/Exclusion Criteria: Key inclusion criteria include imaging-confirmed thoracic aortic disease requiring endovascular repair with a proximal landing zone in the aortic arch (Zone 0) and suitable anatomical features for stent placement. Patients with recent systemic infections, severe coronary artery involvement, or other significant comorbidities were excluded.
Follow-up and Statistical Analysis: Patients will undergo follow-ups at discharge, 30 days, 6 months, and 12 months post-surgery. Statistical analyses will include descriptive statistics of quantitative and categorical variables, with statistical significance set at a one-sided p-value \< 0.025.
This study aims to provide critical insights into the clinical applicability of the QYM technique, potentially broadening therapeutic options for complex aortic arch diseases.
30 studies on the registry are indexed under Dissection, Thoracic Aorta; 10 are open to participants now.
This study's planned enrollment of 87 is close to the median of 87 across 13 interventional studies indexed under Dissection, Thoracic Aorta.
Browse Dissection, Thoracic Aorta studies →Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine is the lead sponsor of 182 studies on the registry; 108 are open to participants now.
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Diagnosis: Patients with the following thoracic aortic conditions confirmed by imaging (CTA):
Aortic Anatomy:
Access Vessel Anatomy:
Exclusion Criteria:
Hematologic Abnormalities:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Autoimmune disease
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
NYHA class (heart failure)
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hemoglobin (Hb)
The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Life expectancy
The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
In this study, all participants will undergo the Quick Yielding Modified (QYM) technique, which combines thoracic endovascular aortic repair (TEVAR) with in situ fenestration and revascularization of the supra-aortic branches. This technique is designed to treat patients with complex aortic arch diseases, including thoracic aortic dissection, true and pseudoaneurysms, penetrating aortic ulcers, and intramural hematomas. The procedure aims to provide a minimally invasive alternative to open surgery, allowing for the effective reconstruction of the aortic arch and its branches. The study will assess the safety and efficacy of this technique, with key outcomes including the incidence of major adverse events (MAE) and the long-term success of the treatment.
Device: QYM Technique
The intervention in this study involves the application of the Quick Yielding Modified (QYM) technique for the treatment of complex aortic arch diseases. This procedure consists of two main components: 1. Thoracic Endovascular Aortic Repair (TEVAR): This minimally invasive procedure utilizes a covered stent graft to exclude the diseased segment of the thoracic aorta, providing immediate protection against rupture and controlling blood flow. 2. In Situ Fenestration and Revascularization of Supra-Aortic Branches: Following TEVAR, the QYM technique includes creating fenestrations in the stent graft to allow for the revascularization of the supra-aortic branches (such as the brachiocephalic, left common carotid, and left subclavian arteries). This is achieved through direct puncture and reconstruction of the branch vessels, ensuring adequate blood flow to these critical arteries while preserving their function. The combination of these techniques aims to achieve effective treatment out
Incidence of Major Adverse Events (MAE) Within 30 Days Post-Operation
This primary outcome measure evaluates the safety of the Quick Yielding Modified (QYM) technique by assessing the incidence of major adverse events (MAE) occurring within 30 days following the surgical intervention. Major adverse events include any significant complications that could impact patient health and recovery, such as stroke, myocardial infarction, aortic rupture, organ failure, or death. The goal is to determine the short-term safety profile of the intervention, providing critical information on its clinical viability for patients with complex aortic arch diseases. Data will be collected through patient monitoring, clinical assessments, and medical records during the specified follow-up period.
Time frame: 30 days post-operation
Aortic Treatment Success Rate at 12 Months
This secondary outcome measure assesses the effectiveness of the Quick Yielding Modified (QYM) technique by evaluating the rate of successful treatment of the aortic condition at 12 months post-intervention. Treatment success is defined as the absence of significant complications, such as re-intervention or aortic-related adverse events, and the proper functioning of the thoracic stent graft with no significant endoleaks. This measure provides insight into the long-term effectiveness and durability of the surgical intervention.
Time frame: Up to 12 months post-operation
All-Cause Mortality
This secondary outcome measure records the rate of all-cause mortality among participants within the study period, allowing for an evaluation of overall patient survival following the intervention. It provides crucial data on the safety and effectiveness of the QYM technique in comparison to the underlying risk of mortality associated with complex aortic arch diseases.
Time frame: Up to 12 months post-operation
Aortic-Related Mortality
This secondary outcome measure focuses specifically on mortality directly related to aortic conditions or complications arising from the surgical intervention. This measure helps to evaluate the long-term safety of the QYM technique concerning life-threatening aortic issues.
Time frame: Up to 12 months post-operation
Incidence of Severe Adverse Events
This measure tracks the occurrence of severe adverse events in participants, including complications such as stroke, myocardial infarction, and organ failure that are serious enough to require medical intervention. Monitoring these events provides a broader understanding of the risks associated with the procedure.
Time frame: Up to 12 months post-operation
Occurrence of Type I or III Endoleaks
This measure evaluates the incidence of Type I or Type III endoleaks following the intervention. Endoleaks are complications that can lead to re-intervention, and monitoring them is critical for assessing the effectiveness of the stent graft placement.
Time frame: Up to 12 months post-operation
Rate of Stent Graft Migration
This measure assesses the migration of the thoracic stent graft from its original position within the aorta. Stent migration can affect the success of the procedure and requires careful monitoring to ensure the stent remains securely in place.
Time frame: Up to 12 months post-operation
Patency Rate of Revascularized Branch Vessels
This measure evaluates the patency (openness and functionality) of the revascularized supra-aortic branches at follow-up visits. A high patency rate indicates successful reconstruction and blood flow restoration to these vessels.
Time frame: Up to 12 months post-operation
Rate of Conversion to Open Surgery or Reintervention Due to Aortic Complications
This measure tracks the incidence of participants who require conversion to open surgery or additional interventions due to complications related to the aorta after the initial procedure. It provides insight into the long-term risks and effectiveness of the QYM technique.
Time frame: Up to 12 months post-operation
Incidence of Major Adverse Events (MAE) at 12 Months
This measure assesses the occurrence of major adverse events (MAE) within the 12-month follow-up period. Major adverse events include complications such as stroke, myocardial infarction, aortic rupture, or death. Monitoring the incidence of these events over the long term provides additional data on the safety and durability of the Quick Yielding Modified (QYM) technique.
Time frame: 12 months post-operation
Freedom from Aortic Rupture
This outcome tracks the percentage of participants who remain free from aortic rupture following the QYM technique over the course of 12 months. Aortic rupture is a life-threatening event, and the goal is to assess whether the intervention effectively prevents this complication in patients with complex aortic arch diseases.
Time frame: 12 months post-operation
Freedom from Reintervention
This measure evaluates the percentage of participants who do not require additional surgical or endovascular interventions on the thoracic aorta or supra-aortic branches after the initial procedure. The goal is to assess the long-term effectiveness of the QYM technique and its ability to prevent the need for further treatments.
Time frame: 12 months post-operation
Plan to share: No
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